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N+R_CP_vol4

10 References 1. Von Korff M, Miglioretti D. A prognostic ap- proach to defining chronic pain. Pain, 2005, 117:304-313 2. Von Korff M, Dunn K. Chronic pain reconsidered. Pain, 2008, 138:267-276 3. Papageorgiou AC, Croft PR, Ferry S, Jayson MI, Silman AJ. Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester back pain survey. Spine 1995 20: 1889-94. 4. Croft PR, Macfarlane GJ, Papageorgiou AC, Tho- mas E, Silman AJ. Outcome of low back pain in general practice: a prospective study. BMJ 1998 316: 1356-9. Spine 1995 20: 1889-94. 5. Dunn K, et al. Contributions of prognostic fac- tors for poor outcome in primary care low back pain patients. Eur J Pain, 2011, 15: 313-319 back pain annually4 . This places a considerable burden on primary healthcare where most back pain management occurs. Back pain is linked to depression and is a major cause of work absence. In patients with back pain, risk score has been shown to consistently predict the presence of significant pain after 6 months better than did the number of Pain Days. Additional evidence supporting a multivariate approach to defining chronic pain has come from a 12- month study of back pain patients which showed that 85% of poor back pain outcome was related to combined unemployment and high pain intensity. Poor self-rated health, functional disability, upper body pain and pain nuisance were related with pain outcome in over 40% of those with persistent pro- blems5 . These studies have shown that a prospective classification of chro- nic pain based on a multivariate risk score consistently outperformed a classification of chronic pain based solely on pain duration. The risk score approach suggests that chro- nic pain should be defined by the likelihood that clinically significant pain will continue in the future, not only by how long the pain has la- sted. Conclusions Since pain outcomes are highly variable over time and between individuals, chronic pain should be viewed as a condition whose future implications are uncertain and liable to change. Defining chronic pain prospectively accepts that chronic pain has multiple attributes, inclu- ding psychological and behavioural outcomes in addition to pain seve- rity and duration. A multi-factorial risk score places the emphasis on additional factors other than pain, suggesting alternative ways in which patients may be helped rather than just by pain control. By broadening the definition, both cli- nicians and patients may become more aware of other opportunities to improve pain outcomes. The risk score approach is another consi- deration that has the potential to CHANGE the current way that we use to assess PAIN. COMMENTARY Professor Joseph Pergolizzi, of the Johns Hopkins University School of Medicine discusses the multi-dimensional nature of chronic pain The conventional definition of chronic pain according to duration has limited empirical support and does not account for the multi- dimensional nature of chronic pain. Other parameters such as social implications, psychological status, functional impairment and per- spectives all need to be taken into consideration. This approach is currently being further evaluated in the SELECT study, part of the CHANGE PAIN initiative, which involves re-interviewing 1000 patients from the NHWS survey who reported moderate to severe back pain. The objectives are to improve understanding of patients’ own defi- nition of chronic pain and its impact, and to investigate the effect of factors such as variation in pain intensity, recall bias and degree of activity impairment.

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